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M 11 'f- ' c .! .r.J- L £ <br />Environmental Health Department <br />1. <br />2. <br />Address. <br />3. <br />5. <br />8. <br />t <br />X SANJOAOUIN <br />-----COUNTY------ <br />GrcolflCJS jro'.vs Sere. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />7. a <br />* syfe <br />Avenue I Stockton. CaKfamte 95205 [ T 209 468-34201 F 209 464-0138 | www.sjgov.org/ehd <br />awisrw ’’•9*’Of 11 TEMP EVENT APR <br />Al food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator threap) weeta prior to this event. Webeptov^i Rarraers Market Sundays <br /> MakK&t <br />The following is information about m^oroanijaiion/business. <br />Name of organizalion/business: [X. INKv-Z ---------------- <br /> <br />Phone: 4«3-(^54____Me.J< ? ' _ .1 snsuteP rice, roSM 04k\keai aoobc’, wJsirf'oKK* <br />List food to be sold or given to the publicrxHiCX^-l Q .TcCjIHO, <br />WMfiA, C7l <br />I am providing food that is NOT prepared at home: ^fYes No \VATEK. ' <br />Al food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: Phone: ( ) <br />Address of facility: <br />I am providing a boolh with the following: (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />Q A booth with wals and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />feforn® M iSlfc kWil&t. W TO Atk feEp<i| ftEjfTS X6CV&. <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />& ApprouBd water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />^Approved bottled water. <br />Q Ori-site hose bib that is connected to a potable water source. <br />UZbther (specify): lklUj6iW Col^4hJ <br />Electricity is provided for my booth's use: Yes ptlo / ’ ' <br />1 foodsdurinsStiiMShrSh” toge^sure the hat and holding of potentially hazardous <br />’ a«wVldinfl f010**19 b* ^P^fore control for the hot holding of all potentially hazardous foods above <br />®Camp stove stemo & hotel trays <br /> Double steamer (ZTSteam table & lids <br />D Electric stove top ^Other (specify) <br />NOl<K haMrdou8 too*1 include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.